| アブストラクト | BACKGROUND: Antiseizure medications (ASMs) during the first trimester of pregnancy have been associated with an increased risk of miscarriage. METHODS: We carried out a population-based cohort study using routinely collected healthcare data from the UK, 1995-2018. Pregnancies were identified in the Clinical Practice Research Datalink and we estimated the HR of miscarriage associated with prescriptions of ASMs during the first trimester of pregnancy, using Cox regression, adjusting for potential confounders, including ASM indications. RESULTS: ASMs were prescribed during the first trimester in 7832 (0.8%) of 1 023 787 included pregnancies. 14.5% of pregnancies with first-trimester exposure to ASMs ended in miscarriage, while 12.2% without ASM exposure in the first trimester ended in miscarriage; after adjustment, there was a 1.06-fold relative hazard of miscarriage (95% CI 1.00 to 1.13) in women with first-trimester ASM use. After restricting to women with specific ASM indications, this association was not evident in women with epilepsy (adjusted HR 0.98, 95% CI 0.89 to 1.08), but was observed in women with bipolar or other psychiatric conditions (1.08, 95% CI 1.00 to 1.16) although CIs overlapped. Compared with discontinuation of ASMs prior to pregnancy, there was no evidence of increased risk of miscarriage for first-trimester ASM use in women with bipolar or other psychiatric conditions (1.02, 95% CI 0.87 to 1.20). CONCLUSION: We found no clear evidence to suggest that first-trimester ASM use increased the risk of miscarriage. Taken together, our analyses suggest that apparent associations between first-trimester ASM use and miscarriage may be the result of confounding by the presence of a bipolar disorder or associated unmeasured variables. |
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| 投稿者 | Forbes, Harriet; Madley-Dowd, Paul; Ahlqvist, Viktor; Campbell, Jennifer; Davies, Neil M; Liebling, Rachel; Lyall, Kristen; Newschaffer, Craig; Rast, Jessica; Tomson, Torbjorn; Zhong, Caichen; Magnusson, Cecilia; Rai, Dheeraj; Lee, Brian K |
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| 組織名 | Epidemiology and Population Health, London School of Hygiene & Tropical Medicine,;London, UK Harriet.Forbes@lshtm.ac.uk.;Centre for Academic Mental Health, Population Health Sciences, Bristol Medical;School, University of Bristol, Bristol, UK.;Medical Research Council Integrative Epidemiology Unit, University of Bristol,;Bristol, UK.;Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.;Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory;Agency, London, UK.;Division of Psychiatry, University College London, London, UK.;K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and;Technology, Trondheim, Norway.;Department of Obstetrics, University Hospitals Bristol and Weston, National;Health Service England, Redditch, UK.;Department of Epidemiology and Biostatistics, Drexel University School of Public;Health, Philadelphia, Pennsylvania, USA.;College of Health and Human Development, The Pennsylvania State University,;Pennsylvania, Texas, USA.;A.J. Drexel Autism Institute, Philadelphia, Pennsylvania, USA.;Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.;Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm,;Sweden.;Avon and Wiltshire Partnership NHS Mental Health Trust, Bristol, UK. |
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